Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 20861 | MN |
NPI | 1063425494 |
---|---|
Provider Name | Douglas Albert Drake |
First Address | Golden Valley, MN 55422-4840 |
Second Address | Edina, MN 55435-1706 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2006 |
Last Update Date | 15/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D81913 | (02) |